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1.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(12): 1242-1249, 2021 Dec 15.
Artigo em Inglês, Zh | MEDLINE | ID: mdl-34911607

RESUMO

OBJECTIVES: To investigate the incidence of preterm birth and risk factors for preterm birth. METHODS: A prospective cohort study was performed for the pregnant women in early pregnancy and their spouses, who underwent prenatal examination for the first time in Hunan Provincial Maternal and Child Health Care Hospital from May 2014 to December 2016 and decided to be hospitalized for delivery. A questionnaire survey was performed to collect exposure information possibly related to preterm birth. The hospital's medical record system was used for information verification and to record the pregnancy outcome. A multivariate logistic regression analysis was used to investigate the risk factors for preterm birth. RESULTS: A total of 6 764 pregnant women with complete data were included, and the incidence rate of preterm birth was 17.09%. The multivariate logistic regression analysis showed that a history of adverse pregnancy outcomes, eating areca nut before pregnancy, a history of pregnancy complications, a history of hepatitis, no folate supplementation during pregnancy, medication during pregnancy, active smoking and passive smoking during pregnancy, drinking during pregnancy, unbalanced diet during pregnancy, high-intensity physical activity during pregnancy, and natural conception after treatment of infertility or assisted conception as the way of conception were risk factors for preterm birth (P<0.05). Additionally, the pregnant women whose spouses were older, had a higher body mass index or smoked had an increased risk for preterm birth (P<0.05). A higher level of education of pregnant women or their spouses and lower gravidity were protective factors against preterm birth (P<0.05). CONCLUSIONS: There are many risk factors for preterm birth. Special attention should be paid to the life behaviors of pregnant women during pregnancy, and health education should be strengthened for pregnant women and their spouses to develop good living habits and reduce the incidence of preterm births.


Assuntos
Nascimento Prematuro , Poluição por Fumaça de Tabaco , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco
2.
Microsurgery ; 33(8): 646-51, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23907776

RESUMO

The goal for treatment of osteonecrosis of the femoral head (ONFH) is to relieve pain, preserve the contour of the femoral head, and delay the need for total hip arthroplasty. The free vascularized fibular grafting (FVFG) has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of ONFH. This report aimed to present the clinical results of the use of a modified surgical technique of FVFG for treatment of ONFH. Four hundred and seven patients with 578 hips of ONFH were included. The patients' average age was 36.7 years old (ranging 19-55 years old). The disease was staged from II to V based on the Steinberg classification system. By the modified procedure, the vascularized fibular graft was harvested via a lateral incision with fibular osteotomy prior to the exposure of the vascular pedicle, and the removal of necrotic tissue and inset of graft were performed through an anterior approach. The operative time averaged 90 min for unilateral ONFH (ranging 75-110 min) and 190 min for simultaneous treatment of bilateral ONFH (ranging 160-230 min). The average length of follow-up was 5.0 years (ranging 3-10 years). The complications included one infection in one case, temporary loss of sensation of the thigh in eleven cases, and restricted motion of the great toe in nine cases. The Harris hip score of patients improved from 65.0 to 86.9 on average. Radiographic evaluation showed no changes in 331 hips (57.3%), improvement in 195 hips (33.7%) and necrosis progression in 52 hips (9.0%). Twenty-three hips (4.0%) in 20 patients had total hip arthroplasty during the period. These results show that the modified technique of the use of FVFG for treatment of ONFH yields similar postoperative results in comparison to the traditional method.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Fíbula/transplante , Retalhos de Tecido Biológico/transplante , Adulto , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fíbula/irrigação sanguínea , Seguimentos , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
ScientificWorldJournal ; 2013: 708014, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24324377

RESUMO

Free vascularized fibular grafting (FVFG) has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH). This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips) who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not received corticosteroids treatment after operation. The mean follow-up duration was 5.4 years for the postoperative corticosteroid administration group (PCA group) and 5.0 years for the control group. At the latest follow-up, the average increase in Harris hip score was 11.1 ± 8.7 points for all hips in the PCA group and 12.6 ± 7.4 points for all hips in the control group (P > 0.05). In the PCA group, through radiographic evaluation, 49 hips were improved, 10 hips appeared unchanged, and 8 hips appeared worse. In the control group, 47 hips were improved, 13 hips appeared unchanged, and 7 hips appeared worse. The results suggested that postoperative maintenance doses of corticosteroids do not have an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH.


Assuntos
Corticosteroides/efeitos adversos , Aloenxertos Compostos/efeitos dos fármacos , Aloenxertos Compostos/transplante , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/cirurgia , Alotransplante de Tecidos Compostos Vascularizados/efeitos adversos , Adolescente , Corticosteroides/administração & dosagem , Adulto , Feminino , Rejeição de Enxerto , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Resultado do Tratamento , Adulto Jovem
4.
J Reconstr Microsurg ; 29(6): 387-92, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23588546

RESUMO

Although free vascularized fibular grafting (FVFG) has been successfully employed for precollapsed osteonecrosis of the femoral head (ONFH), there are few reports concerning its radiographic and functional results for ONFH concomitant with osteoarthritis (OA) of the hip. In the current study, 12 patients with OA induced by traumatic ONFH were enrolled, with FVFG employed as the treatment protocol. The collapsed step of the cartilage surface was measured and compared with the postoperative value, and the Merle d'Aubigné scoring system was used to evaluate preoperative and postoperative status of the hip joint. The collapsed step disappeared, and sphericity of the femoral head could be restored at an average duration of 56 months postoperatively in seven patients. With regard to the severity of hip OA, six were improved to Grade 1 and one to Grade 2. In terms of functionality, all patients with a restored femoral head experienced postoperative improvement in pain relief, mobility, and functional capacity. The average Merle d'Aubigné score increased from 6.0 to 16.9 postoperatively (p < 0.001). In conclusion, for traumatic ONFH concomitant with OA, FVFG can confer benefits in the form of restoration of the contour of the femoral head and improvement in joint function.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Fíbula/irrigação sanguínea , Retalhos de Tecido Biológico/irrigação sanguínea , Osteoartrite do Quadril/cirurgia , Adolescente , Adulto , Fatores Etários , Transplante Ósseo/efeitos adversos , Estudos de Coortes , Feminino , Necrose da Cabeça do Fêmur/complicações , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Fíbula/transplante , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/diagnóstico por imagem , Medição da Dor , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
5.
Med Sci Monit ; 18(7): BR259-64, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22739725

RESUMO

BACKGROUND: It is controversial whether an early reduction and internal fixation can reduce the occurrence of femoral neck fracture-induced osteonecrosis of the femoral head (ONFH). This prospective study was designed to reflect the relationship between injury-to-surgery interval (ISI) and traumatic ONFH based on a canine model of femoral neck fractures. MATERIAL/METHODS: Twenty-four dogs were equally divided randomly into 3 groups. A lateral L-shape approach centered left great trochanter was used for exposure of the femoral neck. A low-speed drill was used for making displaced fractures in the narrow femoral neck, with the femoral head kept in situ with ligamentum teres intact. In Group A, the fracture was immediately reduced and fixed with 3 parallel pins; while the operation was done 3 days later in Group B, and 3 weeks later in Group C. Another 2 dogs had their fractures untreated. Postoperatively, all dogs were fed separately and received regular x-ray examination. Left femoral heads were harvested for histological examination with a postoperative follow-up of 3.5 months. RESULTS: The canine model of femoral neck fractures could be achieved successfully. Radiological signs of post-fracture ONFH could not be detected at intervals of 2 weeks, 4 weeks, 1 month and 2 months. Histologically, there were 2 cases with ONFH in Group A, 1 case in Group B, and 2 cases in Group C. The difference had no statistical significance. For untreated fractures, obvious ONFH could be found radiologically. CONCLUSIONS: A shorter ISI may not reduce the incidence of fracture-induced ONFH, which suggests that intrinsic factors play an important role in the occurrence of ONFH.


Assuntos
Modelos Animais de Doenças , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Animais , Cães , Fraturas do Colo Femoral/patologia , Cabeça do Fêmur/irrigação sanguínea , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Distribuição Aleatória , Fatores de Tempo
6.
J Bone Joint Surg Am ; 104(23): 2108-2116, 2022 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-36325763

RESUMO

BACKGROUND: There is currently no ideal treatment for osteochondral lesions of the femoral head (OLFH) in young patients. METHODS: We performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm 2 ) OLFH treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Twenty patients ≤40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping. RESULTS: All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up. The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months. The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both). Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients. The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months). The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up. CONCLUSIONS: ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Cartilagem Costal , Humanos , Feminino , Masculino , Adulto , Adulto Jovem , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Qualidade de Vida
7.
Orthop Surg ; 13(4): 1205-1212, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33942553

RESUMO

OBJECTIVE: To compare the accuracy of combined independent risk factors in assessing the risk of hip fractures in elderly women. METHODS: Ninety elderly females who sustained hip fractures (including femoral neck fractures and intertrochanteric fractures) and 110 female outpatients without a hip fracture were included in our cross-sectional study from 24 November 2017 to 20 May 2019. The age of subjects in the present study was ≥65 years, with the mean age of 78.73 ± 7.77 and 78.09 ± 5.03 years for women with and without elderly hip fractures, respectively. Bone mineral density (BMD), Beta-carboxy terminal telopeptide (ß-CTX), N-terminal/mid region (N-MID), and 25(OH)D levels were analyzed. A novel evaluation model was established to evaluate combined indicators in assessing hip fractures in elderly women. RESULTS: Compared with the control group, taller height (155.68 ± 6.40 vs 150.97 ± 6.23, P < 0.01), higher levels of ß-CTX (525.91 ± 307.38 vs 330.94 ± 289.71, P < 0.01), and lower levels of total hip BMD (0.662 ± 0.117 vs 0.699 ± 0.111, P = 0.022), femoral neck BMD (0.598 ± 0.106 vs 0.637 ± 0.100, P = 0.009), and 25(OH)D (15.67 ± 7.23 vs 29.53 ± 10.57, P < 0.01) were found in the facture group. After adjustment for confounding factors, logistic regression analysis revealed that 25(OH)D (adjusted OR 0.837 [95% CI 0.790-0.886]; P < 0.01), femoral neck BMD (adjusted OR 0.009 [95% CI 0.000-0.969]; P = 0.048) and height (adjusted OR 1.207 [95% CI 1.116-1.306]; P < 0.01) remained risk factors for hip fractures in elderly women. Then a model including independent risk factors was established. A DeLong test showed the area under the receiver operator characteristic (ROC) (Area under the curve [AUC]) of 25(OH)D was significantly greater than that for femoral neck BMD (P < 0.01) and height (P < 0.01). The AUC of model including 25(OH)D and height was significantly greater than that of other combinations (P < 0.01). CONCLUSION: 25(OH)D, femoral neck BMD and height were associated with the occurrence of hip fractures in elderly women even after adjustment for confounding factors, and a model including 25(OH)D and height could provide better associated power than other combinations in the assessment of elderly hip fractures.


Assuntos
Fraturas do Quadril/etiologia , Fraturas por Osteoporose/etiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Densidade Óssea/fisiologia , Estudos Transversais , Feminino , Humanos , Incidência , Valor Preditivo dos Testes , Fatores de Risco
8.
J Reconstr Microsurg ; 26(9): 631-5, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20922655

RESUMO

Above-knee amputations are rare injuries that need emergent replantation or primary amputation. Although survival could be achieved in selective cases, postoperative function of the affected limb is usually unsatisfactory and a late amputation has to be performed for poor prognosis or severe complications. Experience of the surgical team may play an important role in primary decision making, which leads us to report one case of above-knee replantation with poor postoperative function and needing a late amputation. Scoring systems, expected results based on our case, and a brief review of literature concerning above-knee replantations are discussed.


Assuntos
Amputação Cirúrgica/métodos , Amputação Traumática/cirurgia , Fraturas do Fêmur/cirurgia , Complicações Pós-Operatórias/cirurgia , Reimplante/efeitos adversos , Amputação Cirúrgica/reabilitação , Amputação Traumática/diagnóstico , Membros Artificiais , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/cirurgia , Complicações Pós-Operatórias/diagnóstico , Reoperação/métodos , Reimplante/métodos , Fatores de Risco , Coxa da Perna/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
PLoS One ; 10(3): e0120234, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25789850

RESUMO

OBJECTIVE: To investigate the prevalence of clinical anxiety and clinical depression in Chinese young and mid-aged patients with osteonecrosis of the femoral head (ONFH) and to analyze their potential risk factors. METHODS: Two hundred and sixteen Chinese patients with ONFH were consecutively enrolled in this cross-sectional study from January 2010 to December 2010. The Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) were used to assess the prevalence of clinical anxiety and clinical depression. An additional questionnaire containing seventeen items of potential risk factors was completed by all patients. Binary logistic regression analysis was employed to reveal potential risk factors of anxiety and depression. RESULTS: The prevalence of clinical anxiety and clinical depression was 20.4% and 21.8% in Chinese young and middle-aged patients with ONFH, respectively. Binary regression analysis showed that independent risk factors correlated with high incidence of clinical anxiety included involved femoral head (OR = 3.168, 95% CI: 1.496 - 6.708) and stages of ONFH (ORIV-V / II = 5.383, 95% CI: 1.664-17.416). Independent risk factors correlated with high incidence of depression included gender (OR = 2.853, 95% CI: 1.467-5.778), comorbid diseases (OR = 4.243, 95% CI: 1.940-9.278) and stages of the disease (OR IV-V/II = 16.963, 95% CI: 4.404-65.331). CONCLUSIONS: Patients with bilateral ONFH are inclined to have clinical anxiety, while female patients and patients with comorbid diseases might tend to get clinical depression. Advanced stages of ONFH are independent risk factors for both clinical anxiety and clinical depression.


Assuntos
Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Adolescente , Adulto , Ansiedade/complicações , Ansiedade/patologia , China/epidemiologia , Estudos Transversais , Demografia , Transtorno Depressivo/complicações , Transtorno Depressivo/patologia , Feminino , Necrose da Cabeça do Fêmur/complicações , Necrose da Cabeça do Fêmur/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Análise de Regressão , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
10.
Orthopedics ; 37(4): e357-61, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24762840

RESUMO

Free vascularized fibular grafting (FVFG) is an effective method to treat corticosteroid-induced osteonecrosis of the femoral head (ONFH). Some patients continued to receive maintenance doses of corticosteroids to treat the primary disease postoperatively. This study was performed to evaluate outcomes of FVFG for corticosteroid-induced ONFH in patients who continued to receive corticosteroids postoperatively. The authors retrospectively reviewed the records of 44 patients (78 hips) who had received corticosteroid treatment for their primary disease after FVFG. They were followed up for at least 2 years (mean, 5.6 years). Demographic details, Harris Hip scores, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and radiographic data were collected and analyzed. The mean Harris Hip score for all hips was 70.9±9.9 points before surgery and increased to 84±12.1 points at the latest follow-up. There were also significant increases (P<.05) in physical component summary score and mental component summary score. According to the latest radiographic evaluation, 49 hips (62.8%) appeared improved, 10 hips (12.8%) appeared unchanged, and only 19 hips (24.4%) appeared worse. Seven hips (9%) underwent total hip arthroplasty during the follow-up period. Therefore, the results showed that FVFG was a viable method of treating corticosteroid-induced ONFH in patients who receive maintenance doses of corticosteroids postoperatively.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Necrose da Cabeça do Fêmur/cirurgia , Fíbula/transplante , Glucocorticoides/efeitos adversos , Adolescente , Adulto , Transplante Ósseo , Feminino , Necrose da Cabeça do Fêmur/induzido quimicamente , Fíbula/irrigação sanguínea , Glucocorticoides/uso terapêutico , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
11.
Eur J Orthop Surg Traumatol ; 22(8): 689-93, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27526071

RESUMO

BACKGROUND: Pain is the core and basic problem in the treatment of osteonecrosis of the femoral head (ONFH). However, it is unclear about the status of pain relief following ONFH treated by free vascularized fibular grafting (FVFG) and the level of pain relief contributed to clinical results. Therefore, we designed a consecutive and prospective study to investigate post-operative pain relief in the treatment of osteonecrosis of the femoral head by FVFG. METHODS: One hundred and fifty-one patients with unilateral osteonecrosis of the femoral head were enrolled consecutively for current prospective study from January to August of 2006. Patients were managed by modified technique of free vascularized fibular grafting. Pre-operative, post-operative Harris hip score (HHS) and Harris pain score (HPS) were recorded and compared statistically, meanwhile, correlation between disease severity and Harris hip score, Harris pain score were revealed. RESULTS: All patients had an average follow-up of 54.3 months. Post-operative Harris hip score could be improved from 73.7 to 83.5 averagely in stage-II patients, 64.6 to 78.9 in stage-III, and 53.6 to 72.4 in stage-IV. As for Harris pain score, it was elevated from 28.8 to 38.6 in stage-II patients, 25.5 to 36.6 in stage-III, and 21.8 to 34.2 in stage-IV. Taken together, HHS was improved from 67.7 to 80.3 (ΔHHS = 12.6), and HPS was improved from 26.6 to 37.3 (ΔHPS = 10.7) averagely. CONCLUSIONS: Harris pain score could be employed to monitor prognosis of osteonecrosis of the femoral head treated by free vascularized fibular grafting. Improvement of HPS was the heaviest contributor to elevation of HHS, and both of them conceived of a close relationship with disease severity.

12.
Injury ; 43(7): 1090-5, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22348952

RESUMO

OBJECTIVE: Free vascularised fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs when combined with use of a locking plate. The progress of fibular hypertrophy is closely related to regain of function, as well as to prevention of stress fractures. Multiple variables affecting fibular hypertrophy were investigated in the current study to elucidate correlative factors. METHODS: Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperatively. Repeated measures analysis of variance was employed to evaluate and compare correlative factors including gender (male vs. female), age distribution (<30 years vs. >30 years), site (femur vs. tibia) and length of bone defect (6-10 cm vs. >10 cm), previous number of operations (once vs. more than twice) and concomitant infection (detected vs. non-detected). RESULTS: All defects could be successfully repaired by FVFG and bone union was achieved uneventfully. The degree of fibular hypertrophy was 0.14%, 11.27%, 31.53%, 58.14% and 71.81% retrospectively at the five follow-up time points. Statistical analysis revealed that the above-mentioned factors did not affect the progress of fibular hypertrophy. CONCLUSIONS: FVFG could be a good choice for the reconstruction of massive bone defects when combined with a locking plate. Factors including gender, age distribution, site and length of bone defects, number of previous operations and infection do not impact the progress of fibular hypertrophy, which implies that intrinsic factors might play an important role in restoration.


Assuntos
Transplante Ósseo/métodos , Fraturas do Fêmur/complicações , Fíbula/transplante , Adolescente , Adulto , Distribuição por Idade , Placas Ósseas , Transplante Ósseo/efeitos adversos , Feminino , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/cirurgia , Fíbula/irrigação sanguínea , Fíbula/patologia , Seguimentos , Humanos , Hipertrofia/etiologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
13.
J Pediatr Orthop B ; 19(1): 66-70, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19898254

RESUMO

Although a large skeletal defect secondary to osteomyelitis in children is not an uncommon problem, there are no descriptions of the management of such a defect with a free vascularized fibular graft in combination with a locking plate. We performed such a technique, after radical debridement and systemic antibiotic treatment, on a 13-year-old boy suffering from a large 10 cm tibial defect secondary to osteomyelitis. Primary union of the graft was achieved at 6 months. No recurrence of osteomyelitis occurred in the 29-month follow-up period, and limb salvage and eradication of the infection were achieved successfully.


Assuntos
Transplante Ósseo/métodos , Fíbula/transplante , Salvamento de Membro/métodos , Osteomielite/terapia , Tíbia/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Placas Ósseas , Transplante Ósseo/instrumentação , Cefuroxima/uso terapêutico , Desbridamento , Fíbula/irrigação sanguínea , Humanos , Masculino , Osseointegração , Osteomielite/complicações , Osteomielite/patologia , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Resultado do Tratamento
14.
Orthop Surg ; 1(4): 258-63, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22009872

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. METHODS: Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9-70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. RESULTS: All patients were followed up for 6-20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4-8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow-up. CONCLUSION: Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fraturas não Consolidadas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Consolidação da Fratura , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
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